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n8k
Contributor ⭐
March 31, 2025

United Healthcare

  • March 31, 2025
  • 5 replies
  • 2052 views

Given the current litigation and press about United Healthcare and their propensity to delay and denial care, how can AARP continue to support this company?

      5 replies

      GailL1
      GailL1
      Community Champion ⭐⭐⭐
      March 31, 2025

      UPDATED 04/04/2025 - THE ON AGAIN / OFF AGAIN CYCLE CONTINUES

      STAT 04/04/2025 - DOJ urges judge to move forward with Medicare Advantage fraud case against UnitedHealth 

       

      Previous post from 03/31/2025

      This case has been resolved and UHC won the legal battle - unless the government wants to refill the case - it has been going on for a long time now so maybe they should just drop it and perhaps CMS could clarify their rules and procedures for these risk assessments.

      KFF Health News 03/04/2025 - UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments 

       

      The prior approval requirement is equivalent to other health insurance and is always included in managed care plans.  The provider knows how to submit the appeal to make sure that their medical protocols have been covered or they can do it and then follow the scientific documented way of treatments.   People should understand what it means to use a managed care plan - for Medicare or Medicaid.

       

      IMO, traditional Medical should require more not less prior approvals - they already do some and now hopefully more will be added - this would save Medicare money and would help keep down Part B premiums and even rises in Medigap premiums if they did.   

      IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
      N
      n8kAuthor
      Contributor ⭐
      April 1, 2025

       The Illinois data shows UHC has a denial rate of 18% after appeals. MA denial rates for SNF are 20% while denial rates for traditional medicare are 3%. CalPERS is suing UHC for insider trading and fraudulently increasing risk scores. AARP should be ashamed!

       

      Doctors detail profit-driven changes after UnitedHealth takeover | STAT

       

      What United Healthcare Doesn’t Want You To Know

        GailL1
        GailL1
        Community Champion ⭐⭐⭐
        April 2, 2025

        Have you ever looked at the Medicare National Coverage Determination website?  

         

        Many times this is the source of a prior approval.  The scientific bases of the treatment requested is outside of the protocols.  It is easy enough to fix with the doctor reviewing their files and or making sure their treatment codes meet the qualification needs.

         

        I also read on the CMS site that only denials would be lower IF AN APPEAL IS ACTUALLY FILED -

        KFF.org - Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 

         

        from the link ~

        Just 11.7% of denied prior authorization requests were appealed to Medicare Advantage insurers in 2023.

        The majority of the 3.2 million denied prior authorization requests were not appealed, similar to previous years. In 2019, just 7.5% of all denials were appealed. That share increased somewhat in 2020 to 10.2% and was relatively stable in 2021 (10.6%) and 2022 (9.9%) (Figure 4). These include appeals of determinations that were both fully and partially denied.

         

        Ever had an appeal of treatment under the traditional Medicare program?

        CMS.gov- Levels of Appeal: Redetermination by a Medicare Contractor 

         

        There are FIVE levels of Appeal - I can tell you that with working closely with the doctor and the insurer of a MA plan, it is even easier there.

         

        The solution is clear - make BOTH coverages - traditional Medicare and Medicare Advantage insurers do the SAME thing in prior authorizations and appeals.  

        IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna
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